<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Reporter un problème</title>

<link rel="stylesheet" type="text/css" href="css/style.css">
<script type="text/javascript" src="js/jquery-2.0.3.js"></script>
<script type="text/javascript" src="script.js"></script>

</head>

<body>



<div id="main-container">

	<div id="form-container">

    <h2>Quel est votre problème ?</h2>
    
    <form id="contact-form" name="contact-form" method="post" action="">
      <table width="100%" border="0" cellspacing="0" cellpadding="5">
        <tr>
          <td width="15%"><label for="application">Application</label></td>
          <td width="70%"><select class="validate[required,custom[onlyLetter]]" name="application" id="application" >
						  
						  </select> 
         <td width="15%" id="errOffset">&nbsp;</td>
        </tr>
      <tr>
          <td><label for="useCase">cas d'utilisation</label></td>
          <td><select class="validate[required,custom[onlyLetter]]" name="useCase" id="useCase" >
						 
						  </select> 
         </td>
          <td>&nbsp;</td>
        </tr>
        <tr>
          <td><label for="libelle">Votre problème</label></td>
          <td><input type ="text" name="libelle" id="libelle" class="updateSearch"></input></td>
          <td>&nbsp;</td>
        </tr>
        <tr>
          <td><label for="descriptif">descriptif</label></td>
          <td><input type ="text" name="descriptif" id="descriptif" class="updateSearch"></input></td>
          <td>&nbsp;</td>
        </tr>
        <tr>
          <td><label for="userAction">Action</label></td>
          <td><input type ="text" name="userAction" id="userAction" class="updateSearch"></input></td>
          <td>&nbsp;</td>
        </tr>
        <tr>
          <td valign="top"><label for="mErreur">Message</label></td>
          <td><textarea name="mErreur" id="mErreur" class="validate[required]" cols="35" rows="5"></textarea></td>
          <td valign="top">&nbsp;</td>
        </tr>
       
        <tr>
          <td valign="top">&nbsp;</td>
          <td colspan="2"><input type="button" name="button2" id="button2" value="Envoyer" />
      	 
        </tr>
      </table>
      </form>
      
    </div>
    


	


<div id="test"></div>
</div>
</body>
</html>
